Provider Demographics
NPI:1891499182
Name:KIM, JENNY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1025
Mailing Address - Country:US
Mailing Address - Phone:267-242-2590
Mailing Address - Fax:
Practice Address - Street 1:3515 WEST MORELAND RD.
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-659-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC18570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist